Former Amgen Sales Reps Say They Were Encouraged To Illegally Access Patient Records

By cwaltersJanuary 11, 2008

Two former sales reps for the pharmaceutical company Amgen are suing “for lost wages and other compensation after refusing to participate in improper promotion of the company’s blockbuster psoriasis drug Enbrel.” They claim that Amgen encouraged them to “illegally access patient records to induce insurance carriers to pay for the pricey drug,” according to their attorney. Amgen promptly responded that the suits were without merit, and then handed out blister packets of popular drugs, branded desk calendars, and free t-shirts, so everything’s cool.

Enbrel is a redonkulously expensive injectable drug that “has an annual cost of about $16,000 for a psoriasis patient.”

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“Redonkulously expensive?” Wasn’t there just a huge thread on here a while back about a liver transplant patient, where the general opinion seemed to be that an insurance company should never refuse to pay for any treatment that a doctor recommended, regardless of the cost and potential benefit?

Wow, here’s another example of mandatory arbitration, the article says this suit is in arbitration as required in their employment agreements. I guess they won’t be winning this, unless it’s true and Amgen pays them some hush money.

I’ve been on Enbrel for 5 years now (arthritis). I recall the price being about the same when I started, so it seems the competition mentioned hasn’t lowered the cost at all. My monthly supply still costs more than the refrigerator I use to store it. When I started treatment, Amgen let me know they had a team ready to work “with me” to solve any insurance issues that might come up.

I have a friend with psoriasis who has suffered for years with an insurance company that refused to pay for the drug, despite her doctor’s concern for the disease’s rapid, continuous progression since childhood. Her employer recently switched insurers and the new company covers almost the entire cost of the drug. It is dumbfounding to think that for a few hundred dollars a month the insurance can provide the drug that would cost thousands otherwise, and even more confusing that one can cover it and the other cannot.

@bohemian: Look at the LA Times article. (I was unable to link to it).

From the article.

The two former salespeople contend that Amgen executives inappropriately instituted a promotional campaign in 2005 to pump Enbrel sales by requiring salespeople to visit dermatologists’ offices and request to look through medical files.

If allowed, they say, the sales team would search for patients with psoriasis, then compose and send letters — on the doctor’s letterhead and signed by the physician — suggesting patients consider Enbrel.

In some cases, they said, the salespeople would pose as office employees and contact insurers to request whether a patient could get pre-approval to use Enbrel, clearing the way for physicians to prescribe the drug.

The two former employees filed evidence in the arbitration proceedings including company memos, supporting e-mails, documents and an audio recording made by a sales manager to Engelman that partially describe or make reference to the sales program at issue.

Both former employees say doctors weren’t directly paid for access to patient files. But many of the same doctors who allowed access to their patient charts, they say, were paid as much as thousands of dollars to host dinners and lectures advising physicians and patients about the drug.

@CumaeanSibyl:
The reason Enbrel is so redonkulous is that it is a biologic. It is literally grown in a cell culture (in this case Chinese Hamster Ovary cells) and then highly purified. This process is not only hellaciously expensive during normal production, the development costs are insane too.

At the pharma I worked at just one part of the multistage purification process costs $1mil and can only be used once.

I read just today that Enbrel is being injected into Alzheimer’s patients it seems to help reverse the disease, at least for a while. [www.bloomberg.com]
So, $16,000.00 annually for psoriasis? Maybe, maybe not.
But what if it works for Alzheimer’s? How much is it worth then?

/don’t work for a drug company or own stock – did have a parent die of Alzheimer’s, though.

Make your jokes about dandruff and heartbreak, but this is serious shit. I take a shot of Enbrel every week for psoriatic arthritis; I probably would be unable to type and definitely unable to walk if it wasn’t for this stuff. I cannot ride a bike, run or do anything strenuous. When I was 22 years old I was pulled over for speeding in East Chicago Indiana and wound up in the police station because the psoriasis plaque on my left elbow was cracked and bleeding, leaving little blood spots on my shirt sleeve (psoriasis sufferers ALWAYS wear long sleeves). The cop was convinced I had just injected heroin or cocaine or something and the only thing that saved me was the desk sergeant, whose wife also had psoriasis. He chewed the cop a new asshole right in front of me and then called my boss the next day because I was about to get fired for missing work.

I didn’t respond to most arthritis medications and before Enbrel was taking methotrexate, which was seriously trashing my liver (equivalent to 6 whiskeys EVERY DAY, one doctor said) and didn’t help my arthritis symptoms that much. My Enbrel would cost about $1000 a month but I pay only $60 because of health insurance (thank you Aetna). If I didn’t have insurance I’d still find a way to pay for it because this stuff is a real miracle and it has totally changed my life.

@voltronguy: Okay, that makes sense. If it’s insanely expensive to produce, then of course it’s high-priced. I was thinking it might be one of those drugs that’s priced high because it works well and the manufacturers want to gouge insurance companies.

The drug may be expensive, but it works. My dad has had psoriasis my entire life (along with the attendant joint issues). Enbrel is the only thing that has cleared up the psoriasis. Honestly, I don’t care what Amgen is doing as long as they’re getting insurance to cover a drug that is so effective.

Data mining in patient records is nothing new. I worked for a company that was having trouble financing their R&D for improvising the electronic medical record, and sunk a big chunk of change into the prospect of also selling the info contained therein. We have Bill Clinton and HIPPA to thank for that not happening.

@alice_bunnie: Enbrel’s real life is as an arthritis drug for very severe auto-immune cases. It costs my sister $1200/month.

@No-little-toe: “I didn’t respond to most arthritis medications and before Enbrel was taking methotrexate, which was seriously trashing my liver (equivalent to 6 whiskeys EVERY DAY, one doctor said) and didn’t help my arthritis symptoms that much.”

Oh, man, you and my sister. (Only she takes the methotrexate WITH the Enbrel!) She’s bitter because she pukes constantly from the drugs AND gains weight from them.

@Leah: great that your father has been helped by Enbrel, but you would think twice about what Amgen has allegedly done if you knew they were looking at your medical records and soliciting you without your consent. HIPAA laws are in place to protect you, and others from that level of prying. Without that protection, you could be denied insurance coverage based on any “prior condition” and the financial risk implied to treat you.

@bohemian: actually, it’s pretty painfully easy to steal medical records. There are many people who go in and out of clinics every day, and there’s not really security, so to speak. I used to work as a clerk in a surgical clinic, and to steal records would be as easy as waiting for all the nurses to go on lunch break. Most clinics have more than one way inside; all you would have to do was take the back way, and find the chart room or storage room.

For as sensitive as that information is, it’s pretty rediculous how easy it is to steal.

@thatgirlinnewyork: Just to point out the insurance companies already know what you have, they have this gigantic database called the MIB (i kid you not) that they dump in all of your information they collect once you sign them HIPAA forms and that information is freely sharable to other insurance companies once it’s in the MIB database.

My younger brother has psoriasis, basically looks like he has a hardcore case of chicken pox..all the time. Its even in his ear canals. He is 16.
I have it too, just 3-4 spots at a time.
He’s been on almost everything they can put someone under 18 on. His current doctor has been wanting to put him on this since it became know that this was good for psoriasis. Our last insurance company denied it-why? It was listed as an arthritis drug-it was going to be ‘off-label’ usage. I think after the current medicine he is on is proven its not help Enbrel is the next step. We are counting down the days.